Hasil untuk "Medical philosophy. Medical ethics"

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DOAJ Open Access 2025
Ethics of disclosure of onset‐predictive biomarker test results for genetic frontotemporal dementia in the research context

Charlotte H. Graafland, Laura Donker Kaat, Edo Richard et al.

Abstract Onset‐predictive biomarker tests (OPBTs) for genetic frontotemporal dementia (FTD) may predict symptom onset in coming years. OPBT results could be used as inclusion criterion for clinical trials for FTD, but this requires disclosure of OPBT results to potential participants for informed consent. This creates a dilemma, as disclosure may be psychologically burdensome. Yet, individuals at risk of FTD may value OPBTs to relieve uncertainty and support planning for the future. This article provides an overview of considerations regarding disclosure using four themes (actionability, respect for autonomy and informed consent, psychological impact, social and societal impact), based on literature on return of individual research results and biomarker disclosure in Alzheimer's disease. Based on this, we argue that clinical validity and context of use are important considerations, and suggest that (1) counseling facilitates informed decision making, (2) clinical and psychological follow‐up provides necessary support, and (3) impacts may be monitored in a pilot study. Highlights Ethical considerations regarding disclosure of onset‐predictive biomarker test (OPBT) results include actionability, respect for autonomy and informed consent, psychological impact, and social and societal impact. The weight of each consideration depends heavily on the clinical validity of the OPBT results and the context of use. OPBT result disclosure to individuals at risk of genetic frontotemporal dementia (FTD) for clinical trial recruitment seems ethically acceptable. We suggest embedding OPBT results disclosure in counseling, follow‐up, and a pilot study on impacts of OPBT results disclosure.

Neurology. Diseases of the nervous system, Geriatrics
DOAJ Open Access 2025
Disclosure of onset-predictive biomarker results to research participants at risk of genetic frontotemporal dementia: a European perspective

Charlotte H. Graafland, Eline M. Bunnik, Barbara Borroni et al.

Abstract Background As understanding of biomarkers for genetic frontotemporal dementia (FTD) advances, there is a need to develop onset-predictive biomarker tests (OPBTs) to detect changes before the onset of symptoms. OPBTs can be used to recruit carriers or individuals at 50% risk of carriership into clinical trials of investigational therapies targeting the preclinical and prodromal phases of FTD. OPBT results should be disclosed as part of the informed consent process, with positive results indicating that symptom onset is likely in the next few years. This information can be psychologically burdensome, especially in individuals at 50% risk, for whom a positive OPBT result would reveal their genetic status. There is a need for ethical guidance for disclosure processes to help researchers implement disclosure of OPBT results responsibly at their study sites. Methods Existing literature on disclosure of genetic and biomarker results in neurodegenerative conditions informed the design of this disclosure process for OPBT in FTD. Drafts were discussed with the multidisciplinary research team, scientific and clinical FTD experts across European countries, and other stakeholders and revised accordingly. Results The suggested disclosure process provides guidance for first-time or repeated disclosure of OPBT results to carriers or individuals at 50% risk of genetic FTD in research settings. Conclusions Researchers involved in clinical trials using OPBTs can adopt this disclosure process as a framework for responsible communication of OPBT results at their study site. The process was designed for international applicability and facilitates the alignment of disclosure processes for clinical trial recruitment across European countries.

Neurosciences. Biological psychiatry. Neuropsychiatry, Neurology. Diseases of the nervous system
DOAJ Open Access 2024
The criterion of human dignity in the Quran

Seyed Abdosaleh Jafari, Behin Araminia, Nafiseh Tavasoli et al.

In the Holy Quran, a strong emphasis has been placed on the dignity of human beings. There are two verses in the Quran that discuss the differences between humans and other creatures. In this article, we have tried to interpret these two verses using free selection of virtues and goodness as the criterion for human dignity that was obtained in our previous research. In the verse of trust, unlike other creatures, man accepts a trust that informs us about his cruelty and ignorance.  However, if we consider this trust as freedom of choice, it can also imply injustice and ignorance alongside justice and wisdom for humans. In the verse of succession, angels tell God that human as vicegerent on earth leads to corruption and bloodshed. God does not deny this, but reminds the angels of the existence of pure ones. If we consider freely choosing goodness the differentiating factor between humans and other creatures the angels accurately refer to the possibility of creating corruption and bloodshed. However, they did not see the value of voluntary goodness compared to their own compulsory goodness.Therefore, by considering freely choosing goodness as the criterion for human dignity, these two verses can be easily interpreted.

History of medicine. Medical expeditions, Medical philosophy. Medical ethics
DOAJ Open Access 2024
La búsqueda de la felicidad en la literatura de autoayuda. Un desafío para la bioética

Federico Vásquez Cardona , Daniel Valencia Cartagena, José Arroyave Carvajal

Esta investigación propone el análisis de los posibles riesgos asociados al consumo de libros de autoayuda, donde hay una constante búsqueda inmediatista de soluciones a los problemas de la vida cotidiana. El trabajo se enmarca en la metodología de artículo teórico. Se realizó una revisión bibliográfica en bases de datos científicas y de humanidades, además de considerar los antecedentes y el contexto relacionados con el tema abordado, seguido de un análisis de la información. Como resultado, se evidenció que existen riesgos asociados al uso de la autoayuda como método de solución para los problemas que afectan al sujeto contemporáneo en la sociedad, debido a la posibilidad de transgredir los principios de la bioética, además de la ausencia de implementación de los fundamentos acerca del alcance de la felicidad proporcionada por la neurociencia.

Jurisprudence. Philosophy and theory of law, Medical philosophy. Medical ethics
DOAJ Open Access 2022
An Experimental Study of the Interventional Effects of Qigong Exercise on College Students with Different Personality Types

Lingling Yu于玲玲, Xiaolei Liu, Yunbi Shou et al.

This paper explored the effects of practicing Qigong, a traditional Chinese fitness method which includes the imitation of the Fiveanimal exercise, on the psychological adjustment of college students with different personality types. Through the study of 220 college students aging from 19 to 22 a study of the responses made on the Eysenck Personality Questionnaire (EPQ) and Symptom check list-90 (SCL-90)] provided scientific data that supported the idea that Chinese traditional health preservation exercises can improve the mental health of college students. Specifically, after 12-week Qigong exercise, the total symptom index, interpersonal sensibility, obsessive-compulsive, paranoid-anxiety, depression, psychoticism and anger-hostility of the participants significantly differed from baseline. There were also significant differences in somatization and anxiety. In the female participants in the experimental group, there was a very significant difference in terms of anger-hostility, and there were also significant differences in terms of paranoid-anxiety and psychoticism, and in somatization, depression and the total symptom index. Further improvements are described.

Medical philosophy. Medical ethics
DOAJ Open Access 2022
Expanding the Duty to Rescue to Climate Migration

David N. Hoffman, Anne Zimmerman , Camille Castelyn et al.

Photo by Jonathan Ford on Unsplash ABSTRACT Since 2008, an average of twenty million people per year have been displaced by weather events. Climate migration creates a special setting for a duty to rescue. A duty to rescue is a moral rather than legal duty and imposes on a bystander to take an active role in preventing serious harm to someone else. This paper analyzes the idea of expanding a duty to rescue to climate migration. We address who should have the duty and to whom the duty should extend. The paper discusses ways to define and apply the duty to rescue as well as its limitations, arguing that it may take the form of an ethical duty to prepare.  INTRODUCTION Climate migration creates a special setting for a duty to rescue. A duty to rescue is a moral rather than legal duty and imposes on a bystander to take an active role in preventing serious harm to someone else. Examples of circumstances range from person-to-person intimate rescue to saving those in poverty, even in distant parts of the world.[1] Since 2008, an average of twenty million people per year have been displaced by weather events.[2] Circumstances like being thrust from homes under the threat of fire, mudslide, and flooding vary greatly from long-term changes like land becoming too arid for crops or temperatures increasing annually gradually pushing up the number of heat-related deaths, with the area slowly becoming uninhabitable. Imminence in fleeing affects resettling and need for rescue with important implications for how the duty to rescue might apply. This paper reevaluates the ethical framing of the duty to rescue and, while it is arguably a stretch, applies it to climate migration.  Climate migration has become common and is expected to increase due to rises in sea level, increases in weather events that make areas uninhabitable, and changes to land that preclude farming or other necessary land uses. We argue that a duty to rescue may help highlight who has moral obligations to whom.  Because the problem is so large in scope, we suggest a change in the ethical limits to humans' duty to rescue other humans who are in distress. We imagine an expansion or extension of the duty to rescue to meet some of the basic needs created by climate migration. Yet how it should expand, and how much depend on ethical framing and practical limitations. l.     Expanding the Geographical Boundaries Two commonly recognized emergencies, Hurricane Katrina in the case of weather events and the current COVID-19 pandemic, provide a historical and current backdrop to evaluate ethical obligations as more disasters displace people. A significant reassessment of the ethical scope of an obligation to rescue in the case of weather events will be limited by the ability to render aid to those in distress in the case of a planet-wide weather catastrophe. The problems may overwhelm the ability to rescue or the reasonableness of attempting rescue. The extent of the moral obligation borne by humans to other humans in the case of a weather event has been largely defined by its locality and limited geographic influence. Whether we are imagining the scope of ethical obligation in the case of hurricane, flood, tornado, drought, or wildfire events, the perceived ethical obligation is significantly defined by the limited impact of these weather events on people outside the zone of the weather event's direct impact, yet close to that zone. A hurricane affecting New Orleans will not have immediate impact on the residents of California or even those on the northeast coast of the United States until a later time. Wildfires in the Pacific Northwest do not impair the ability of those in the rest of the country to come forward with assistance. But as climate migration crosses international borders, and climate events occur simultaneously in many regions, a more expansive duty to rescue may provide the ethical impulse to help those who live afar or migrate long distances.  In this respect, the need for help in the event of widespread climate migration due to global warming is more like a pandemic than a weather event. Its broad impact area diminishes the capability of nearly the entire balance of the human population to help due to those populations' awareness that they will, in short order, have the same need for the same resources, from the same cause. Those living near current flood zones may find their historically safe havens are also a flood zone. Those previously best positioned to rescue may find themselves also needing to relocate. Thus, we may observe the need for new rescuers. ll.     The Rule of Rescue The Rule of Rescue as defined by Al Jonsen describes the moral impetus or knee jerk reaction to save identifiable people facing death.[3] A duty to rescue has since been expanded beyond imminent death and beyond the near and identifiable. But there are limitations. For example, by most accounts, the ethical duty tends not to require extreme bodily risk or financial depletion. In comparing Good Samaritans to humanitarians, Scott M. James argues the duty to rescue arises from unique dependence, but the ethical obligation to help strangers through humanitarian aid is of a different nature.[4] The wrongness of failing to help is arguably more egregious when one is in a unique position to help. Like in the tragedy of the commons, where there is no unique positioning, when the global community is called upon to help, each individual in it may feel less obliged to do so. Climate migration falls in between—it requires helping strangers, yet it may move forward without anyone seeing themselves as uniquely positioned to help until those strangers become part of communities, at which time, there may be more moral justification to help a community member in need. Generally, arguments about Good Samaritans hinge on extraordinary acts, praiseworthy because they are acts of compassion, not obligation. Now all US states have Good Samaritan laws[5] which protect helpers from liability for help gone wrong or for a failure to succeed once engaged in an act of rescue. Extraordinary help as a moral good is thus somewhat encouraged through legal protection, but not imposed. Conversely, jobs like firefighting, search and rescue, and emergency medical care tend to oblige employees to take on risks that would be extraordinary if undertaken by the average bystander, yet they are rendered ordinary rescue as part of the job. Three states, Minnesota, Rhode Island, and Vermont have a broad duty to rescue, adding legal considerations to an otherwise moral conundrum. The laws do not require bystanders to take on risk for the sake of rescuing strangers.[6] The moral duty will require looking beyond law, but it is unclear how the moral duty to rescue should be distributed in the case of climate migration. A bare minimum would prevent taking advantage of newcomers, paying sub-minimum wage, and discriminating against them. Yet such a minimum is hardly rescue. lll.     An Ethical Rather than Legal Duty The difficulty in defining the duty to rescue as a legal obligation is that it is difficult to determine the extent of risk a rescuer ought to be required to take. The nature of this ethical duty is also arguably tied to the experiences of both the rescuer and the rescued. There are subjective aspects like what someone perceives as a danger that make it difficult to write enforceable laws requiring rescue. It is one thing to expect a rescuer to step into several inches of relatively warm water to lift a person lying face down in a pond and enable them to breathe. It is something altogether different to expect that rescuer to dive into frigid water and attempt to extricate someone trapped in a submerged automobile. As the legal philosopher H.L.A. Hart observed, it is always easier to define application of the core intention of any rule, whether law or ethical norm. It is more difficult to create legal certainty about how the law applies to what he described as “penumbra circumstances”. In the case of a hurricane, it is easier to define what surplus resources are available in areas geographically remote from the impact of the storm and demand, as a moral obligation, that those nearby but outside the area provide assistance. It is more difficult to obligate people, organizations, or governments to supply a quantity of medication or some number of ventilators to an adjacent community when they expect to imminently need them for their own community. In the early stages of climate migration, the ethics of extreme weather event assistance, a common application of the duty to rescue, will be useful and appropriate. The rising sea levels first experienced by island nations in the South Pacific[7] will not render those living in other coastal communities, those with greater available “high ground”, unable to supply resources to those in need. But when sea level rise and climate change affect more communities simultaneously, albeit in varying degree, the task of defining what response is ethically obligatory becomes increasingly complicated. Pinpointing the obligations of those communities which are resource rich to those communities which are resource deprived, and of those partly affected to those more severely affected may become necessary.  The limitations of the traditional duty to rescue could expand to meet the needs. lV.     Contribution to the Problem Many argue that the duty to rescue may depend on any appropriate claim of those needing rescue. One issue is whether preferential claims among those who can identify the source of the harm should call for a greater duty or whether everyone in need should be approached as like candidates for rescue, shaping the duty as equal across those on the receiving end. As climate change does have human-made causes, there are strong arguments to impose a greater ethical duty on any entity that caused the climate-related problems leading to the mass exodus. While the global north is often implicated in pollution that causes migration, industries like energy, transportation, and agriculture are tied to climate change and associated with significant greenhouse gas emissions.[8] Practices like directing agriculture to less sustainable single crop growth generally made land less farmable. Yet it is difficult to place blame and identify specific causal relationships as most migration is due to many factors. A movement toward greater accountability can be reframed as a greater duty to rescue, a duty to engage in the extraordinary. The fossil fuel industry, for example, should have a larger obligation than the average person. Similarly, some may argue anyone unjustly enriching themselves while contributing to climate change or people who over-consume have an elevated duty to rescue.[9] Climate change lawsuits demonstrate an eagerness to hold governments and corporations accountable, despite difficulty proving causation. V.     The Most Vulnerable One ethical dimension of climate migration that remains unexplored is how a duty to rescue applies to vulnerable populations who stand to be left behind or unable to migrate without assistance. Researchers from the Global North working across the Global South are increasingly observing the phenomenon of ethics dumping, where the research ethics of some countries are imposed on research subjects in other countries.[10] In that vein, rescuers should be careful not to impose unwelcome cultural standards or exploit people who are in the process of migrating. There is a gap in discussions reflecting voices that have been left out. The duty to rescue is incomplete without an attempt to understand the ethical experiences of those being rescued. The actual people affected by climate migration who are the least likely to have the means to migrate, or to do so without extreme hardship, should have a voice informing the global community including those in a position to carry out rescue. People who have the means and are young and healthy may easily make decisions to avoid the catastrophic consequences that climate migration brings. However, what about those who are left behind? For example, especially recognizing cultural differences, the homeless community, disabled community, refugees, the elderly community, and women[11] and children may suffer differently and call for more attention. In some parts of the world, human rights are severely constrained. An ethical duty to rescue, with many considerations and variables, may be more justified in the case of those most in need. As climate migration continues and increases significantly, it may be reasonable to ask the local and global community to focus on those least well positioned to migrate successfully. In this context, the use of phenomenology to understand the lived experiences of those migrating, sometimes termed “ethical experiences”, may help flesh out how a duty to rescue takes shape. The discussion of duty and obligation requires an articulation of the ethical experiences (how the local community in need of rescue views the proposed rescue).  Then, the obligation to interpret the duty as ‘one shall not’ or ‘one must’ can be focused on the migrants’ needs rather than the rescuers’ feelings of obligation.[12] A revised theory of the duty to rescue taking into account the asymmetrical experiences of communities involved could ensure that the needs of people whose living situations, gender, ethnicity, age, or race impact their ability to even begin the migration process are considered. In this discussion, the rescuing is directed toward communities /collectives of persons migrating, whether at once or across a period of time. Often, the climate migrant may not be in a state to articulate the nature of this event when it happens, given its subjective proximity. Yet, when communities are given the space and opportunity to articulate their shared values, the ethical action of rescue derives its meaningfulness from the community rather than the rescuers.  In other words, allowing climate migrants to explain their feelings can add complexity to what some see as a binary receiver-giver (of rescue) dynamic. This is necessary because the concept of vulnerable populations is fraught with problematic assumptions. There have been various definitions and criteria to determine what would constitute vulnerable populations.[13] For example, the United Nations Framework Convention on Climate Change[14] identifies and assesses vulnerable populations. These criteria may be helpful. However, they do not provide the full picture. Rather than identifying categorical criteria of vulnerable populations, engaging with people who are experiencing climate migration and listening to their current experiences and concerns helps determine need. Knowing what people need may prevent the kneejerk reaction to label people who are quite resilient yet have appropriate needs “vulnerable”. Proceeding with caution is important because the duty to rescue has hierarchical underpinnings of "us" and "them." Often when people swoop in to save, there are good and bad consequences of the intervention. We should proceed with caution because often the helper misses the actual needs of those in need. The only way to combat this would be to make sure that people are empowered to inform those agencies that are able to help.  In addition to more practical approaches, large scale oral histories could allow those who have migrated already to share their experiences. It would be important to capture the lived experiences of people who are already experiencing the consequences of climate migration or of other migration like that due to political or economic extreme events. These experiences could shape our analysis of whether people in fact wish for rescue. If so, further conversations can determine best actions as well as give important insight into what resources might be necessary to empower people now and in the future.  Vl.     A Duty to Rescue as a Duty to Prepare If we view Good Samaritans as going above and beyond, then a duty to rescue, something ethically compelled, must bring rescue out of the framework of charity and place it in the context of humanity and obligations. Such a view would also support expanding the geographical reach of the otherwise more proximate duty. The duty may be stronger and take shape in a more workable way if it applies to preparing places expecting to see an influx of people due to climate migration and to helping those most in need. The duty may arise out of expectations of what type of community the place welcoming those migrating due to climate should be—does it want to offer good housing, schooling, and medical care as well as economic opportunity to new people? And if so, at what cost, or with which risks? If the newcomers are viewed as community members rather than strangers, a model of acceptance may lead to better preparation. Some considerations like whether the actions will reasonably help the persons in need of rescue[15] will shape the application of a duty to rescue in the context of climate migration. Similarly, ensuring that people have the chance to articulate their values may help communities support the newcomers. New relationships should not be defined as migrant and rescuer. Voluntariness in participation and not forcing any action deemed rescue would help ensure the human rights of those migrating. In the United States, President Biden issued an executive order addressing impending climate migration steeped in a duty to prepare by making plans for resettlement and to address the impact of climate migration.[16] Vll.     At What Risk? As we investigate the ethical obligations to meet even basic needs, we must also ask what level of risk is ethically compelled. There is an extraordinary need to integrate newcomers successfully, but it is difficult to stretch an ethical duty to rescue to require all the prerequisites for successful climate migration. Even defining success would create deep ethical arguments. As observed in almost all migrations, extraordinary charitable acts may be the key to success, while an ethical duty to rescue must try to require the important government and community-based basics and ensuring respect for human rights. That is, the migrating people should be rescued from circumstances that contradict basic human rights. Rather than comparing communities to bystanders, mere places where people will arrive and need to hash out how to find housing, jobs, education, and opportunity, a duty of preparation may be the key to rescue those disenfranchised by migration. There are cultural, personal, physical, psycho-social, and geopolitical issues surrounding how to best help those needing to permanently relocate. Ethics arguments will certainly range from “do nothing”, which may fail people, to “do everything”, which could waste taxpayer money in futile over-preparation while failing to actually help. Communities must avoid planning exclusively for one scenario only to have it not take place. Striking the balance, a duty to rescue as it could apply to climate migration should set goals of societal integration, and providing the basics like education, housing, food, health care, and job opportunity, the precursors to flourishing. Recommending the extraordinary, morally preferred but perhaps not compulsory, when charitable actors are participating, or when wrongdoers are compensating, may be more workable than seeing the duty to rescue as compelling people or local governments to take on significant financial and personal risk for newcomers. While humanitarian ethics supports helping everyone, it is likely that people who resettle in advance of a need to flee will find themselves with more choices and opportunities. Help is warranted for those with more dire needs. Preparing for them may do just that. Vlll.     Rescue Prior to Migration and Rescue in the Process of Resettlement The duty to enable the migration in the first-place hints to the inadequacy of a duty to prepare. The traditional duty to rescue perhaps steps in if rescue looks like those geographically just out of harm's way rescuing those in danger. That resembles the traditional moral requirement, or duty to rescue according to the Rule of Rescue. Humanitarian aid typically provided by many institutions makes sense and is in place, although financial support for additional humanitarian aid is always needed. Despite having moved to purportedly more capable communities, migrant communities may be able to develop more egalitarian orders of living.  Rather than continually being identified as having been rescued, it is important to make sure people keep or make social ties during and after migration.  Immigrants often face social isolation.[17] Small shifts in gestural language also have the potential to welcome people and show they are valued. For instance, some migrants may not like questions like “Where are you from?” and “What brings you here?” as they emphasize differences over fitting in. CONCLUSION The ethical duty to rescue should be expanded to better match those in need of relocation with a welcome environment and the resources needed to achieve success and fully integrate socially and culturally. Expanding a dialogue that includes the voices of people who have recently migrated whether due to violence, poverty, or climate, could properly frame the extent of the duty. If we are to apply the duty of rescue to climate migration, rescuers should avoid labeling people vulnerable, dependent, or needy, although there is reason to focus on those whose needs are the most dire. A soft duty to rescue people during the course of climate migration can come in the form of preparation. People will need help finding housing, education, access to food, and employment. Ultimately, to help them help themselves may be the best goal. While the obligations should be borne differently by people, whether due to a special responsibility, or a special relationship that creates a clearer duty, the global community must prepare for its role in rescuing those displaced by climate events. By helping those displaced at the start of the climate migration process according to a more commonly held notion of the duty to rescue, and by preparing to incorporate newcomers successfully according to an expanded duty to rescue, effectively a duty to prepare, countries that take on climate refugees may find themselves rewarded by the cultural diversity and workplace talents that people bring. A duty to those at a distance is a reasonable expansion of the duty to rescue. But what one ought to do in the global community varies somewhat from the traditional Rule of Rescue.  - [1] Singer, P. (1972). Famine, Affluence, and Morality. Philosophy and Public Affairs, 1(3): 229-43. [2] Irfan, U. (2022, March 16). Why We Still Don’t Yet Know How Bad Climate Migration Will Get. Vox. https://www.vox.com/2022/3/16/22960468/ipcc-climate-change-migration-migrant-refugee, citing the International Panel on Climate Change (IPCC) (2022). Sixth Assessment Report, Climate Change 2022, Impacts, Adaptation, and Vulnerability. https://www.ipcc.ch/report/ar6/wg2/  [3] McKie, J., Richardson, J. (2003) The Rule of Rescue. Social Science & Medicine, 56(12):  2407-2419. https://doi.org/10.1016/S0277-9536(02)00244-7. [4] James, S.M. (2007). Good Samaritans, Good Humanitarians. Journal of Applied Philosophy, 24(3):238-254. [5] Overview of Good Samaritan laws. https://worldpopulationreview.com/state-rankings/good-samaritan-law-states [6] Fifield, J. (2017, Sept. 19). Why It’s Hard to Punish ‘Bad Samaritans’. Stateline Blog, Pew Charitable Trusts, https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2017/09/19/why-its-hard-to-punish-bad-samaritans [7] Cassella, C. (2019). There’s a Climate Threat Facing Pacific Islands That’s More Dire Than Losing Land, Science Alert, https://www.sciencealert.com/pacific-islanders-are-in-a-climate-crisis-as-rising-sea-levels-threaten-water; Hassan, H. R., and Cliff, V. (2019). For Small Island Nations, Climate Change is not a Threat. It’s Already Here, World Economic Forum, https://www.weforum.org/agenda/2019/09/island-nations-maldives-climate-change/ [8] For example, Lyons, K. (2019). Australia Coal use is Existential threat to Pacific Islanders, The Guardian.  https://www.theguardian.com/world/2019/aug/12/australia-coal-use-is-existential-threat-to-pacific-islands-says-fiji-pm  [9] Cripps, E. (2013). Climate Change and the Moral Agent: Individual Duties in an Interdependent World. Oxford: Oxford University Press. [10] Schroeder, D., Chatfield, K., Singh, M., Chennells, R., and Herissone-Kelly, P.. Ethics Dumping and the Need for a Global Code of Conduct. In Cham. (Ed.)(2019). Equitable Research Partnerships. SpringerBriefs in Research and Innovation Governance. Springer.  2019. https://doi.org/10.1007/978-3-030-15745-6_1 [11] Giudice L.C., Llamas-Clark E.F., DeNicola N., Pandipati, S., Zlatnik, M.G., Decena, D.C.D., Woodruff, T.J., Conry, J.A. (2021). Climate Change, Women’s Health, and the Role of Obstetricians and Gynecologists in Leadership, International J Gynecol Obstet, 155(3), 345-356. 10.1002/ijgo.13958 [12] See Ferrarello, S. and Zapien, N. (2020). Ethical Experience: A Phenomenology, Bloomsbury. (for understanding phenomenological determinants of ethical action). [13] McLeman, R.A., Hunter, L.M., (2010). Migration in the context of vulnerability and adaptation to climate change: insights from analogues. Wiley Interdiscip Rev Clim Change, 1(3): 450-461. [14] Least Developed Countries Expert Group. (2018). Considerations Regarding Vulnerable Groups, Communities and Ecosystems in the Context of the National Adaptation Plans: United Nations Framework Convention on Climate Change. [15] Jecker, N.S. 2013. "The Problem with Rescue Medicine." J Med Philos, 38(1):64-81. [16] White House Report. (February 9, 2021), Executive Order (E.O.) 14013, “Rebuilding and Enhancing Programs to Resettle Refugees and Planning for the Impact of Climate Change on Migration.” (calls on the National Security Advisor to prepare a report on climate change and its impact on migration. “This report marks the first time the U.S. Government is officially reporting on the link between climate change and migration.” https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/27/executive-order-on-tackling-the-climate-crisis-at-home-and-abroad/ [17] Torres, J.M., Casey, J.A. (2017) The centrality of social ties to climate migration and mental health. BMC Public Health, 17: 600. https://doi.org/10.1186/s12889-017-4508-0

Medical philosophy. Medical ethics, Ethics
DOAJ Open Access 2022
The “One Health” approach in the face of Covid-19: how radical should it be?

Vittorio A. Sironi, Silvia Inglese, Andrea Lavazza

Abstract Background The 2020-2021 coronavirus (Covid-19) pandemic is just the latest epidemic event that requires us to rethink and change our understanding of health. Health should no longer be conceived only in relation to human beings, but in unitary terms, as a dimension that connects humans, animals, plants, and the environment (holistic view, One Health). In general, alterations occurring in this articulated chain of life trigger a domino effect. Methodology In this paper, we review the One Health paradigm in the light of the Covid-19 pandemic and distinguish two approaches within it that might be dubbed the Prudent one and the Radical one. Each approach is structured in three levels – epistemological, medical, and ethical. Results In this way, we show how we humans can better address the pandemic today and how, in the future, we can treat the whole living system better, by renouncing our anthropocentric perspective on health. Conclusion We hold that the Prudent approach can be very helpful, and we discuss the medical and ethical issues related to it. We also consider the Radical view and the epistemological turn it requires compared to the Prudent one.

Medical philosophy. Medical ethics
DOAJ Open Access 2021
The Effects of Acceptance and Commitment Therapy With and Without Compassion on Spiritual Fatalism and Depression in Diabetic Patients

Tahereh Panahi, fatemeh shahabizadeh, alireza Mahmoudirad

Background and Objectives: There exists a relationship between spirituality and depression. Moreover, psychological interventions are effective in this regard. Thus, this study aimed to investigate the effects of Acceptance and Commitment Therapy (ACT) with and without compassion on spiritual fatalism and depression in non-clinically depressed diabetic patients. Methods: This was a quasi-experimental study with a pre-test, post-test and follow-up and a control group design. The statistical population included all non-clinical depressed patients with type 2 diabetes in the welfare centers of Mashhad City, Iran, in 2020. To form 3 research groups using the purposive sampling method, 33 subjects were selected and randomly divided into the study groups. Moreover, after 2 months, a follow-up test was performed on the research groups. The research instruments included the Patient Health Questionnaire (Depression) by Arbi et al. and the Diagnosis Scale of Egede and Ellis Diabetes. Results: The repeated measures analysis of variance data suggested that the ACT approaches with and without compassion intervention were effective in increasing spiritual fatalism (P<0.05) and reducing depression (P<0.05) in the explored nonclinical depressed diabetic patients. Moreover, the follow-up data revealed the stability of the collected results (P<0.05). Conclusion:ACT, as an effective intervention can be used in medical centers to increase spiritual fatalism and reduce depression in diabetic patients with depression vulnerability.

Medical philosophy. Medical ethics
DOAJ Open Access 2021
Reflexiones bioéticas sobre el consentimiento de personas con discapacidad en la toma de decisiones en salud

Blanca A. Arcos, Verónica M. López, Ma. de la Luz Casas et al.

En la atención médica y en la investigación en salud resulta indispensable favorecer la toma de decisiones de los pacientes y/o participantes bajo el principio de autonomía. En particular, esta capacidad, consignada en la Convención de los Derechos de las Personas con Discapacidad, se concreta mediante la detección de necesidades de asistencia, ajustes y apoyos que dan paso a una plena y efectiva capacidad de ejercicio.  Las reflexiones bioéticas hechas desde la perspectiva principialista, personalista y de los Derechos Humanos ofrecen elementos para potenciar la autonomía de las personas con discapacidad, promoviendo la figura de asistencia personal y enfatizando el interés superior, la gradualidad y la revisión judicial permanente como principios de figuras sustitutivas.

Science, Medical philosophy. Medical ethics
DOAJ Open Access 2019
Kenyan health stakeholder views on individual consent, general notification and governance processes for the re-use of hospital inpatient data to support learning on healthcare systems

Daniel Mbuthia, Sassy Molyneux, Maureen Njue et al.

Abstract Background Increasing adoption of electronic health records in hospitals provides new opportunities for patient data to support public health advances. Such learning healthcare models have generated ethical debate in high-income countries, including on the role of patient and public consent and engagement. Increasing use of electronic health records in low-middle income countries offers important potential to fast-track healthcare improvements in these settings, where a disproportionate burden of global morbidity occurs. Core ethical issues have been raised around the role and form of information sharing processes for learning healthcare systems, including individual consent and individual and public general notification processes, but little research has focused on this perspective in low-middle income countries. Methods We conducted a qualitative study on the role of information sharing and governance processes for inpatient data re-use, using in-depth interviews with 34 health stakeholders at two public hospitals on the Kenyan coast, including health managers, providers and researchers. Data were collected between March and July 2016 and analysed using a framework approach, with Nvivo 10 software to support data management. Results Most forms of clinical data re-use were seen as an important public health good. Individual consent and general notification processes were often argued as important, but contingent on interrelated influences of the type of data, use and secondary user. Underlying concerns were linked to issues of patient privacy and autonomy; perceived risks to trust in health systems; and fairness in how data would be used, particularly for non-public sector re-users. Support for engagement often turned on the anticipated outcomes of information-sharing processes, as building or undermining trust in healthcare systems. Conclusions As reported in high income countries, learning healthcare systems in low-middle counties may generate a core ethical tension between supporting a public good and respecting patient autonomy and privacy, with the maintenance of public trust acting as a core requirement. While more evidence is needed on patient and public perspectives on learning healthcare activities, greater collaboration between public health and research governance systems is likely to support the development of efficient and locally responsive learning healthcare activities in LMICs.

Medical philosophy. Medical ethics
DOAJ Open Access 2019
Examining the ethical challenges in managing elder abuse: a systematic review

Afsaneh Saghafi, Fatemeh Bahramnezhad, Afsaneh Poormollamirza et al.

Elder abuse is an increasingly intangible phenomenon that has created numerous ethical issues for care teams and caregivers. Although different studies have concentrated on various ethical issues regarding abuse, no study has arrived at a comprehensive conclusion. Therefore, the present study aimed to determine the existing ethical challenges in this context. For this purpose, two researchers familiar with systematic search approach examined national and international journals on PubMed, Excerpta Medica Database (EMBASE), Scientific Information Database (SID) and similar databases between January and February 2017. They were able to find 116 articles that met the inclusion and exclusion criteria, and finally selected 15 articles based on the predesigned questions. The findings were classified in five subtitles as follow: 1) the common definition of elder abuse, 2) a comprehensive legislation on elder abuse, 3) comprehensive ethical principles about elder abuse, 4) ethical considerations regarding patients without competency, and 5) reporting and sharing information about elder abuse. The study results revealed no common definition and no legislation about elder abuse, and also showed that health care providers’ observance of ethical principles depends on the ethical and legal conditions of the community. Nowadays, elder abuse is a serious problem in many countries. Cultural and religious differences are the reasons for lack of a common definition and legislations, which comprises the biggest obstacle to protecting the rights of elderly people. It is clear that ethical principles should be respected as far as a person has competency. Furthermore, localization of clinical guidelines related to this issue leads to proper functioning of health care providers, especially nurses as the first line of treatment.

History of medicine. Medical expeditions, Medical philosophy. Medical ethics
DOAJ Open Access 2019
Diagnóstico genético pré-implantação (DGPI): uma eugenia mascarada?

Kalline Carvalho Gonçalves Eler, Kessia Priscila Miranda Ramos, Marco Tulio Pires de Oliveira

Na última década, ganharam destaques tecnologias reprodutivas, sobretudo o diagnóstico genético pré-implantação (DGPI): seleção de embriões saudáveis obtidos através de programas de fertilização in vitro antes de estes serem transferidos para um útero materno. O melhoramento genético pode levar a eugenia positiva, que exclui determinadas enfermidades, ou a eugenia negativa, que abre espaço para que os pais escolham características específicas dos filhos, como pele, cor dos olhos, ou nível de raciocínio. A partir da noção de vulnerabilidade e necessidade de proteção do embrião, defende que não se deve esperar a ocorrência de danos severos para empregar medidas.

Medical philosophy. Medical ethics, Business ethics
DOAJ Open Access 2016
Percepción del cuidado de enfermería dado a los pacientes con cáncer hospitalizados

Narda Patricia Santamaría, Lilia Esperanza García, Beatriz Sánchez Herrera et al.

El objetivo principal de este artículo es describir el estado del arte sobre la percepción del cuidado de enfermería a pacientes oncológicos hospitalizados. Para esto, se hizo una revisión integrativa realizada en 16 bases de datos entre 1994 y 2014, teniendo en cuenta los descriptores percepción, relación enfermero-paciente, hospitalización y oncología, con sus respectivas traducciones al inglés y orientada por el descriptor boleano AND. Se encontraron de esta manera 52 publicaciones sobre la relación enfermera-paciente oncológico hospitalizado; asimismo, se evidenció que estas han ido en incremento, particularmente en la última década. La mayor parte de las publi-caciones son de tipo cualitativo, revisiones o reflexiones. Al revisar en conjunto la productividad académica, se identificaron múltiples formas de abordar esta relación desde el punto de vista conceptual; sin embargo, parece ser su condición de reciprocidad la que resulta más enriquecedora para las partes, lo que permite que los sujetos que intercambian en medio del cuidado de la vida cuando se tiene un cáncer crezcan como personas y ganen en introspección. Así pues, la relación enfermera-paciente con cáncer hospitalizado es un punto central para poder comprender y cualificar las prácticas de cuidado de esta población. Se hace necesario desarrollar estrategias de medición y cualificación de esta interacción.

Medical philosophy. Medical ethics, Ethics
DOAJ Open Access 2010
No departure to "Pandora"? Using critical phenomenology to differentiate "naive" from "reflective" experience in psychiatry and psychosomatic medicine (A comment on Schwartz and Wiggins, 2010)

Bonnemann Catharina, Schlimme Jann E, Mishara Aaron L

<p>Abstract</p> <p>The mind-body problem lies at the heart of the clinical practice of both psychiatry and psychosomatic medicine. In their recent publication, Schwartz and Wiggins address the question of how to understand life as central to the mind-body problem. Drawing on their own use of the phenomenological method, we propose that the mind-body problem is not resolved by a general, evocative appeal to an all encompassing life-concept, but rather falters precisely at the insurmountable difference between "natural" and a "reflective" experience built into phenomenological method itself. Drawing on the works of phenomenologically oriented thinkers, we describe life as inherently "teleological" without collapsing life with our subjective perspective, or stepping over our epistemological limits. From the phenomenology it can be demonstrated that the hypothetical teleological qualities are a reflective reconstruction modelled on human behavioural structure.</p>

Medical philosophy. Medical ethics
DOAJ Open Access 2009
A Brief History of Enviroethics and Its Challenges

Marjan Laal

Environmental ethics has emerged during the early 1970s, when environmentalists started urging philosophers to consider the philosophical aspects of environmental problems. Environmental ethics considers the ethical relationships between humanity and non-human world. The Union of Concerned Scientists, a group of over two thousands scientists, has concluded that climatic change is beyond dispute, and already changing our environment. Environmental instability portend ill for public health and well-being. This paper attempts to apply ethical theories to support environmental concerns and provides moral grounds to preserve the earth's environment. This article documents consensus among environmental philosophers as given by synthesis data provided via survey among articles, websites, and books by the keywords: environment, ethics, health and crises. The field has come to exert significant influence over a large number of human science disciplines in relation to environmental sustainability and human wellbeing. Environmental ethics focuses on the possibility of the identification of human ego with nature, means the larger ecological self deserves respect, too. Environmental ethics expands the boundaries of ethics to include the nature and considers its sustainability to ensure human wellbeing. This study emphasizes mainly on a brief history of environmental ethics and its protection against damage. Environmental changes and extreme weather events in plus to species distinction and a growth of diseases are impossible to hide and ought to be impossible to ignore. The health decline associated with various forms of these changes is continuing. It raises crucial issues about environmental justice.

History of medicine. Medical expeditions, Medical philosophy. Medical ethics

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